Editor’s Note: Megan Ranney MD, MPH, is an associate professor of emergency medicine; co-founder of GetUsPPE; and a CNN medical analyst. Follow her @meganranney. Jessi Gold, MD, MS, is an assistant professor of psychiatry and the director of wellness, engagement, and outreach at Washington University in St Louis. Follow her at @drjessigold. The opinions expressed in this commentary are their own. View more opinion on CNN.
Over the last two weeks, our email, direct messages, and social media feeds have been full of messages from fellow health care workers saying: “I am so tired.”
We, collectively, say that we are “tired” because we have no other, easy words to describe how we are. Struggling in a sea of sleepless nights, rising coronavirus cases, and politicized public health messaging, “tired” is the word that comes to mind. But this word is insufficient, and even minimizing. What we are feeling right now, is so much more.
Most health care workers expected that the autumn would be difficult. We know the history of novel respiratory viruses: the second surge is almost always worse than the first. But as cases, hospitalizations, and deaths waned in the summer, we all hoped against hope that this fall, the story would be different – that our country would come together, wear masks and follow basic social distancing measures. But here we are, with exponentially increasing numbers of Covid-19 cases, hospitalizations, and deaths across the country. There is no sign that disease spread will slow. It is almost beyond the capacity of imagination.
Health care providers know plenty about working hard. And we are not strangers to burnout. Even before Covid-19 hit the United States, our health care system was in trouble. Many emergency departments were overflowing, too often workers were being asked to do more with less, and average Americans couldn’t afford their ever-rising insurance deductibles and premiums. Before Covid-19, physicians already had among the highest suicide rates of any profession.
But health care workers’ experience during Covid-19 is more than “burnout” (defined by the World Health Organization as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed”). Burnout is what we feel in normal times, when the system doesn’t work and when we feel a lack of control. Nothing is normal during a pandemic. Today, the tank is empty and health care workers are running on fumes.
Like the rest of the country, many of us lack child care, are worried about finances and miss our friends. We struggle with our productivity outside of the clinical arena, and we have difficulty with sleep. But we are also stressed in unique ways. We often lack personal protective equipment (PPE). Those of us who own our own practices are budgeting for new, through-the-roof PPE costs at the same time that our revenue is dropping. We worry about our physical safety and the safety of our friends and family: more than 1,700 health care workers have died of Covid-19 in the United States alone, according to a National Nurses United report.
We are also facing unprecedented cognitive dissonance between what we trained to do, and what we can actually provide to our patients. The sheer overwhelm of cases, and lack of resources, is difficult to bear. The most horrible thing for a health care provider, is to be unable to help our patients. When we run out of beds, testing and treatments, we are forced to make decisions that we never thought we would have to make, like who to give the only ICU bed or ventilator to. We’re facing “moral injury” – a concept that originated to describe soldiers’ feelings of “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations” after wartime violence. And, indeed, it feels like we are at war. We already knew all about death and grief, but this is different. As the deaths mount, our nightmares do, too.
Meanwhile, we are accused by strangers on Twitter, by random people in the grocery store and by our country’s elected leaders of lying or being part of a global conspiracy. Even some of our own ranks have alleged – against all physical and statistical evidence – that Covid-19 is “no worse than the flu” or could be fixed with herd immunity – a myth. We cannot begin to describe the feeling of leaving a hospital ward full of patients gasping for breath, only to be told that we are making it up.
What’s more, we have little chance to recover, to recuperate or to practice self-care – and little time to process or feel or acknowledge what it was like for us to experience what we did. Just as the adrenaline subsides, we have to don our protective equipment again, and go into the next room. Without taking time to acknowledge ourselves in the equation, we don’t even learn the words to say we are anxious, pained, saddened, or heartbroken. So we say “tired” because we know what that means.
Part of medical training is self-sacrifice. As trainees, we are lauded for stoicism, for the ability to focus despite long days and tragic cases. This is our “work ethic.” We are discouraged – by teachers and colleagues – from empathizing too deeply with patients, or showing emotion at a loss. Feeling, in a way, is not acceptable. So we use the word “tired” or “exhausted” because physical symptoms are a culturally acceptable answer in a field – and a world – that still stigmatizes mental health difficulties.
Get our free weekly newsletter
So, no, we are not just complaining. When we don’t use different – more dramatic – words to describe our experience, it doesn’t mean we’re fabricating it. The hospitals aren’t empty just because our parking lots are, and we aren’t profiting off of Covid-19 deaths.
We aren’t lying to you when we say you have Covid-19. And, when we ask you to wear a mask, it is not for our personal or political gain, it is because it could save lives.
If you know us, or see our faces, you understand.
We are exhausted, scared, and shaken. Because, after all, we’re human.